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Thoracic Pain: Why Does My Middle Back Hurt?

From the base of our neck to the bottom of our ribcage is called our Thoracic spine. It is where each of our ribs attach, a lot of our postural muscles insert, and the vertebrae that help keep us upright are located.

Most of us these days suffer from bad posture either due to sitting jobs or sedentary lifestyles and we put a lot of strain through our spines to keep us upright all day everyday. Without the right posture and muscular control, the strain put through our thoracic spine can progress to neck, back, or even shoulder pain that can be very detrimental to our daily function.

Common Thoracic Pain Diagnoses

Pinched Nerves:

The most common diagnosis that I see regarding the thoracic spine is pinched nerves. Coming out from the spine alongside each rib is a nerve and it follows around the rib to the front of the chest and sternum. With a slouched posture comes increased strain to these nerves as they are pinched in the decreasing space of each vertebrae in this position. Sometimes we may even feel pain in the chest or under the breast only and we wonder where it’s coming from.

Almost always, when we treat the thoracic spine, increase your postural endurance, and strengthen your back muscles, this pain goes away and can be managed with simply working to sit up tall more often.


Another diagnosis found in regards to thoracic spine pain is Osteoporosis which is when our bones lose calcium and can become brittle leading to compression fractures in the spine. This requires diagnosis through a bone density scan and can be treated with supplements, injections, and physical therapy to slow the progression.

Physical therapy for someone diagnosed with Osteoporosis would include strengthening the core and postural muscles and gently increasing the mobility of the Thoracic spine to prevent stiffness and loss of motion.


Osteoarthritis is probably the most commonly diagnosed ailment for the entire body and that is because it simply means inflammation of the joints. When not addressed, it can progress to deterioration and joint pain that is hard to manage. However, when treated it can be managed well and one can function normally without daily pain.

The best thing that you can do to treat arthritis is strengthen the muscles around your joints and learn protection strategies to prevent strain to the joint. When our muscles are strong, we have more support around the joints and therefore less strain and wear-and-tear on them which creates inflammation. If we can learn to use these muscles throughout our day, we will give our spine a break and it will last you much longer.

What Steps Should You Take to Get Relief?

  1. Assess your posture. Check out what you look like when you experience the most Thoracic pain. Have someone take a picture of you while you work and are deep in thought. You’ll be amazed at how much we slouch when we are sitting and concentrating on other things.

  2. Do your best to sit up tall; think head to the ceiling. In doing this, you will feel your core muscles: abdominals, buttock muscles, and back muscles contract and have less strain on your back.

  3. Stretch. Do you have a sitting job or spend a lot of time bending over or leaning forward? Give your spine a break and stretch the opposite way: gently lean back over the back of your chair, standing and do a small back bend.

  4. Strengthen. Long-term this is the most important part. An ongoing core and postural strengthening program 3-4 times a week will do you wonders and help you function without pain for years to come.

Not sure how to start or you’re having pain regardless of following these steps? That’s where I come in. So, let’s jump on a quick phone call and figure out what the next best steps are for you so that you can get back to life!

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